Scope of Practice in Massage Therapy

scope of practiceScope of practice is a term used by licensing bodies to outline what is and is not permissible for certain kinds of professionals. A physical therapist’s scope of practice includes therapeutic exercise, but not prescribing psychiatric drugs. That would be within the scope of practice for a psychiatrist, though.

Scopes of practice may include some overlap from one profession to another. Physical therapy assistants can provide massage therapy (although they generally don’t want to; it’s a lot of work!). Physicians and Nurse Practitioners can both diagnose illnesses.

But it gets more confusing than that: because massage therapy is licensed by different agencies from state to state, massage therapists in different states may also have different scopes of practice. The basics are the same everywhere: we work with soft tissue by rubbing, rolling, kneading, compressing, and all that jazz. We can use basic tools like heat and cold. We can use a variety of lubricants, and water. So if that’s what everybody can do, what are the sticky issues, those practices that are in the scope of practice of some massage therapists and not others? Here are four examples that aren’t always the same across the board:

Intra-oral massage

What’s intra-oral massage? It’s massage inside of the mouth. It’s performed with medical-grade gloves on, and used for people with jaw and facial pain. While massage therapy is generally limited to external work, many states permit massage therapists to perform intra-oral work as well. Some require special training (which you’ll want even if it’s not required; why risk messing up somebody’s mouth?), some require a prescription of a physician or dentist, and some places nix the practice altogether.

Breast massage

While working on the pectoral muscles is a part of massage everywhere, there can also be benefits to working directly on breast tissue, especially for women who are pregnant or lactating, or who have had breast surgery, whether medical or cosmetic. That being said, breasts are a controversial body part, and many states are quick to rule the area out of bounds. Special training is required by some states. In nearly all states, massage therapists are required to get the explicit permission of the clients before working on breast tissue (a good idea no matter what your treatment plan is!). In some states where massage therapists are not permitted to directly touch breast tissue, there may be legal alternatives, such as showing the client how to massage their own breasts during the session, or working hand-over-hand with the client.

Assessments and tools

Can you measure your clients’ blood pressure? Weigh them? Use a goniometer to measure range of motion? Depending on your location and the kind of massage education you’ve received, answers might range from “Of course!” to “Why would I ever want to do something like that?” to “What the hell is a goniometer?” The sorts of tools and assessments available to massage therapists does vary from state to state. Even if you work in a non-clinical setting, isn’t it nicer to know exactly what you could do, if you so desired?

Spa treatments

Are wraps and scrubs within your scope of practice where you work, or are those the exclusive domain of trained estheticians? Just because you touch skin all day doesn’t mean that you’re automatically granted permission to provide skincare. Knowing the limitations of your scope can help you know where to invest in further training, and where it’s more worthwhile to develop relationships with other sorts of practitioners instead.

A limited scope of practice is not an insult.

Don’t think about it as The Man trying to keep massage therapists down! In reality, it’s a compliment. Surgeons have a certain scope of practice. So do dentists, psychiatrists, and physical therapists. Having a scope of practice means that someone in the healthcare world takes your education and training seriously enough that they want you to focus on what they know you really know how to do.

Being able to accurately articulate your own scope of practice establishes you as someone who is serious, ethical, and believes in the work that they have been trained in. Is it a bit ridiculous how it varies from state to state? Absolutely; politics is always absurd. But even when we reach the utopian ideal of universal licensure, there will still be a line between Okay and Not Okay. There’s so much amazing work to be done inside your scope of practice, why mess with illegal opportunities outside of it?

Image courtesy of Stuart Miles/